基于跨理论模型动机访谈改善老年高血压患者自我效能及疗效的研究*

目的探讨基于跨理论模型(TTM)动机访谈(MI)改善老年高血压患者自我效能及疗效。方法将286例60～75岁社区老年高血压患者随机分为对照组和观察组,每组各143例,对照组给予社区分层分级管理干预,观察组在社区分层分级管理的基础上开展基于跨理论模型动机访谈干预,两组干预时间均为18个月。干预前后分别测评自我效能、自我管理、血脂水平、血压治疗及控制情况和生存质量,采用t检验和χ2检验比较两组自我效能、自我管理、血脂水平、血压治疗及控制情况和生存质量。结果干预前,两组自我效能、自我管理、血脂水平、血压治疗及控制情况和生存质量之间差异均无统计学意义(P0.05);干预18个月后,观察组自我效能、自我管理、高密度脂蛋白、血压治疗及控制情况和生存质量较对照组均有显著改善(P0.05)。结论基于TTM的动机访谈是有效的认知、行为改变技术,有助于提高患者自我效能和自我管理水平,改善高密度脂蛋白、血压治疗及控制情况和生存质量,值得在社区推广应用。     

人参皂苷Rg3立体异构体差异抑制糖尿病调控基因蛋白-PXR机制的分子动力学研究

目的：为进一步了解Rg3对映体的立体化学选择性,对PXR配体结合结构域（PXR ligand-binding domain,PXR-LBD）中20（R/S）-Rg3的结合模式进行建模。方法：使用计算对接,分子动力学（molecular dynamics,MD）和基本动力学分析（essential dynamics analysis,EDA）等技术手段进行建模。结果：PXR中20（S）-Rg3的MM / PB-SA估计结合能大于20（R）-Rg3。两种配合物的RMSFs表明,20（S）-Rg3结合的LBD的迁移率比20（R）型对映体的迁移率降低得多。EDA预测和两个复合物的叠加三维结构都表明20（S）-Rg3在PXR中的结合比20（R）-Rg3更可能与生物学结果一致。结论：以上结果表明,基于目前的模拟结果,PXR中20（S）-Rg3的结合模式比20（R）-Rg3更有可能与生物实验结果吻合。     

自我效能在宫颈癌患者家庭亲密度与适应性和益处发现间中介效应

目的了解宫颈癌患者益处发现的水平,并探讨自我效能、家庭亲密度与适应性和益处发现3者之间的关系以及自我效能在家庭亲密度与适应性和益处发现的中介作用。方法选取哈尔滨医科大学附属肿瘤医院2016年1—6月入院病理学诊断为宫颈癌、术后3个月的患者239例作为本次调查对象,应用自编一般人口学调查问卷、益处发现评定量表(BFS)、家庭亲密度与适应性量表中文版(FACESⅡ-CV)和一般自我效能感量表(GSES)对宫颈癌患者进行问卷调查。结果本次问卷调查的宫颈癌患者益处发现总分为(65.82±12.12)分,家庭亲密度与适应性总分为(122.08±17.37)分,自我效能总分为(31.57±5.94)分。家庭亲密度与适应性总分及各维度得分与自我效能总分和益处发现总分均呈正相关(P<0.01)。分层回归显示,自我效能在宫颈癌患者家庭亲密度与适应性和益处发现间起部分中介作用,中介效应为0.182,相对中介效应为43.6%。结论家庭亲密度与适应性既可以对益处发现产生直接作用,又可以通过自我效能间接作用于益处发现。自我效能介导了家庭亲密度与适应性对益处发现的正面效应,对宫颈癌患者的益处发现有保护作用。     

Repairing a relationship imperiled by infidelity: combining individual work,Relationship Enhancement® couple therapy and guided visualization to break through an emotional impasse

This article presents an extended case analysis involving the impact of infidelity on an intimate relationship where the emotional connection between the two partners runs very deep but where the involved partner's multiple infidelities and the hurt partner's wounded and defended heart keep them stuck, the couple neither being able to end the relationship nor heal from the emotional trauma to the relationship. The analysis relates the intensive individual work with the involved partner on his personal struggles with ego-driven serial infidelity, the joint work with both partners utilizing the Relationship Enhancement® therapy dialogue process and how the spontaneous introduction of an image and guided visualization helped break the emotional impasse in a manner that permitted the couple to move to a place of genuine healing and reconciliation.     

Twenty-four-week treatment with extended release methylphenidate improves emotional symptoms in adult ADHD

Abstract

Objectives. Treatment investigations with methylphenidate in adults with ADHD focus preferentially on the classical psychopathology: inattention, hyperactivity and impulsivity. ADHD-associated emotional symptoms, which are frequently present at least in ADHD subpopulations, were studied rarely. The vast majority of the placebo-controlled trials had observation periods between 4 and 8 weeks. To assess the medium- to long-term effects of extended release methylphenidate (MPH-ER) on emotional symptoms and other psychopathology frequently seen in ADHD patients, we conducted a large-scale, multicenter treatment study. Methods. We performed a randomised, 24-week, double-blind, placebo-controlled study in adults with ADHD. The diagnosis was made on the basis of the DSM-IV criteria, which were confirmed by clinical history and a structured psychopathological interview and the use of rating instruments. 363 patients were randomized to MPH-ER or placebo at a ratio of 2:1. The duration of the titration period was 5 weeks followed by a maintainance phase of 19 weeks. The efficacy measures were the observer rated 10-item Emotional Dysregulation Scale (EDS) derived from the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) and a self-report, six-item Emotional Lability Scale (ELS) extracted from the long version of the Conners Adult ADHD Self Report Scale (CAARS:S:L). In addition we used the SCL-90-R for the assessment of ADHD associated and comorbid psychopathology. Results. MPH-ER was statistically superior to placebo in reducing emotional symptoms as assessed by the EDS and the ELS. Obsessive-compulsive symptoms and those of problems with self-concept declined until the end of the observation period. The decline was more pronounced in MPH-ER treated individuals. The effects remained robust during the entire maintenance period until week 24. Symptoms of anxiety, depression, anger and hostility, phobia, paranoid ideations and psychoticism were not improved. Conclusions. MPH-ER appears to be an efficacious treatment for emotional symptoms with ADHD. Also obsessive-compulsive symptoms and problems with self-concept were affected positively.     

Validity Study of the CBCL 6–18 for the Assessment of Emotional Problems in Youth With ASD

Youth with autism spectrum disorder (ASD) often present with emotional problems such as anxiety and depression (American Psychiatric Association, 2013). A recent study of the Child Behavior Checklist 6-18 (CBCL; Achenbach & Rescorla, 2001) indicated good sensitivity but relatively low specificity for identifying emotional problems in youth with ASD. The current study examined the extent to which variance in the CBCL’s Anxious/Depressed, Withdrawn/Depressed, Internalizing Domain, and Total Problems scales was accounted for by symptoms of emotional problems relative to ASD symptoms. Correlation and multiple regression analyses indicated that these scales measured anxiety and depression but a small statistically significant proportion of variance in Total Problems scores was also accounted for by ASD symptoms. Results contribute to the emerging evidence base for the inclusion of the CBCL in assessment protocols for assessing emotional and behavioral problems in youth with ASD.     

Gender Differences in the Relationship between Emotional Regulation and Depressive Symptoms

Reports of gender differences in depressive symptoms are one of the most pervasive findings in the literature. In addition, women are frequently reported to be more emotionally sensitive than men. However, the paradox of women being more emotionally responsive and yet at greater risk for psychopathology is still to be unraveled. In the present study we examined emotional regulation as a possible factor in the gender difference in depressive symptom reporting. In a sample of young adults we replicated the frequently reported finding of greater depressive symptom reporting in women. In addition, we found women to report greater attention to emotions. This is consistent with the idea that women tend to think more and ruminate more about their emotions. However, when the variance associated with this greater attention to emotions was statistically controlled, the gender difference in depressive symptoms was no longer significant. Subsequent analyses found that women with low depressive symptoms reported greater attention to emotions without evidencing greater depressive symptoms. However, women with high depressive symptoms exhibited greater attention to emotions, more impaired antirumination emotional repair strategies, and greater reports of depressive symptoms than men with high depressive symptoms. We close by speculating about the neural concomitants of these findings.     

Public self-awareness and withdrawal from social interactions

Women high and low in social self-efficacy participated in a social interaction either under conditions of heightened public self-awareness or in a control condition. The self-awareness manipulation increased self-focused attention and self-evaluation, but only among low-efficacy subjects. Low-efficacy subjects withdrew from the interaction more quickly than did high-efficacy subjects, but only when self-awareness was heightened. Both groups of low-efficacy subjects believed their partners would not like them, and the partners did indeed like these subjects less than the high-efficacy women. These results suggest that low-efficacy women are distinguished by a number of cognitive factors, even in the absence of self-directed attention. Faced with social scrutiny, these individuals engage in a perservative self-evaluation process, which ultimately leads to social withdrawal. The results are interpreted from the perspective of Ingram's (1990) interaction model of self-directed attention.This research was supported by a grant from the Social Sciences and Humanities Research Council of Canada.     

基因工程化Treg细胞对小鼠异基因骨髓移植后急性移植物抗宿主病的作用

目的 探讨输注慢病毒载体介导的鼠基因工程调节性T淋巴细胞(Treg细胞)对小鼠异基因骨髓移植后移植物抗宿主病(GVHD)的影响.方法 利用慢病毒载体介导,将鼠Foxp3基因转导入BALB/c小鼠的CD4+CD25-T淋巴细胞,即为基因工程Treg细胞.建立小鼠异基因骨髓移植模型,在移植时联合输注基因工程Treg,通过受...     

CD4+CD25+调控T细胞及其在移植耐受中的作用

CD4^ CD25^ 调控T细胞是一群表型和功能特异的T细胞亚群,能抑制CD4^ CD25^-和CD8^ T细胞的活化和增殖,以及IL-2和IFN-γ的产生,在移植免疫耐受中发挥着重要的作用,其免疫调控机理仍不明确。CD4^ CD25^ 在体外能有效地被分离、活化和扩增,并能保持其免疫调控能力,其活化后的免疫抑制功能是抗原非特异性的。体外活化和扩增的CD4^ CD25^ 调控T细胞有广阔的应用前景。